Erik Swain , 2025-06-21 18:09:00
Key takeaways:
- An intervention to emphasize weight-related care in primary care settings eliminated weight gain at the population level.
- The intervention produced extra revenue for clinics with no extra time from clinicians.
CHICAGO — An intervention designed to emphasize management of overweight and obesity in primary care settings was associated with prevention of weight gain in more than 250,000 patients, researchers reported.
The PATHWEIGH intervention was implemented across University of Colorado-affiliated primary care practices and its effectiveness was determined with funding by the NIH, Leigh Perreault, MD, professor of medicine at the University of Colorado School of Medicine, said during a press conference at the American Diabetes Association Scientific Sessions.
An intervention centered around primary care management of overweight and obesity induced a 0.58 kg greater weight loss than usual care. Image: Adobe Stock
“UC Health primary care leadership endorsement of PATHWEIGH was critical,” she said. “We were able to get build time from our internal Epic personnel to customize the electronic medical record to facilitate weight-related care. The patient would walk into their primary care clinic and see signage that would say, ‘Would you like medical assistance with your weight? If you would, then please approach the front desk and ask for a weight-prioritized visit type.’ When the patient scheduled that visit, an automated intake questionnaire would be sent to them through the patient portal 72 hours before their visit. As a clinician, when I walk into the room and open my notes, I would see that immediately, and it makes the visit very fast. The note template turns into a big menu of anything we might do for weight-related care, consolidating everything into a single interface so that the provider is not clicking through the record to try to get to what they need. It also has prompts for billing. The participating health care professionals were able to get support from us for anything they did.”
Randomization to the intervention or the usual care occurred at the clinic level, but results were reported at the patient level. During 4 years, 274,182 participants (mean age, 54 years; 54% women) were included in the study, of whom 84,955 were exposed to the intervention alone, 41,772 were exposed to the usual care alone and 147,455 were exposed to both.
Differences in weight at 18 months
At 18 months after the initial visit, those receiving the usual care had a weight gain of 0.47 kg (95% CI, 0.45-0.5) and those receiving the intervention had a weight loss of –0.1 kg (treatment difference, –0.58 kg; 95% CI, –0.52 to –0.61; P < .001), Perreault said during the press conference.
“A counterfactual analysis indicates that the intervention eliminated population weight gain observed during usual care,” Perreault said.
In another analysis, the researchers determined that only 25% of adults with a BMI of 25 kg/m2 or more received discernible weight-related care over 4 years, defined as counseling on lifestyle modification, referral for weight-related specialty care, active use of a weight-loss medication or treatment for obesity outside primary care.
Adults with a BMI of 25 kg/m2 or more were more likely to receive weight-related care if they were in the intervention group as opposed to the usual care group (OR = 1.23; 95% CI, 1.16-1.31), Perreault said during the press conference.
In a secondary analysis, participants were stratified into six groups: 35,505 exposed to the usual care alone who received no weight-related care; 6,267 exposed to the usual care alone who received weight-related care; 103,240 exposed to the intervention and the usual care who received no weight-related care; 44,215 exposed to the intervention and the usual care who received weight-related care; 66,055 exposed to the intervention alone who received no weight-related care; and 18,900 exposed to the intervention alone who received weight-related care. Those who received weight-related care were younger, more likely to be women and more likely to be Hispanic or Latino than those who did not, Perreault said.
Differences by weight-related care
At 18 months after the first visit, among those who received no weight-related care, the usual care group had a weight gain of 0.55 kg (95% CI, 0.52-0.58) and the intervention group had a weight gain of only 0.18 kg (95% CI, 0.15-0.22).
“Weight gain was mitigated during the intervention even when patients did not receive weight-related care,” Perreault said.
Among those who received weight-related care, the usual care group lost an average of –1 kg (95% CI, –0.96 to –1.04) and the intervention group lost an average of –1.73 kg (95% CI, –1.68 to –1.78). In the intervention group, those who received weight-related care lost –2.37 kg more than those who did not (95% CI, –2.33 to –2.4; P < .001), she said.
Among those who received care for weight, the intervention group was more likely than the usual care group to start an anti-obesity medication (14.8% vs. 8.7%) but less likely to have bariatric surgery (0.5% vs. 0.9%), Perreault said.
Costs to implement the intervention were negligible and the intervention required no extra time from clinicians, she said.
In addition, because of more weight-related encounters and better coding, the intervention resulted in more than $15 million in extra revenue for the clinics, Perrault said.
“PATHWEIGH is not a car on the road, it is the road,” Perrault said during the press conference. “It is the unifying road for all weight-related care in the same place.”
Perspective
I think this can be a viable process for health care systems to follow. This study took place in a very large system. If the process can be integrated into the workflow of the providers, it could have an impact. Primary care physicians just do not have enough time. They may only get to talk about two comorbidities in each visit.
Is this going to be adopted by everyone? Is it going to be scalable in all places? I don’t think so. But at least in the primary care world, it could be a wonderful option to have.
Amy Hess-Fischl, MS, RDN, LDN, BC-ADM, CDCES
Disclosures: Hess-Fischl reports no relevant financial disclosures.
Sources/Disclosures
Collapse
Perreault L, et al. Symposium – PATHWEIGH trial – Building the highway for weight management in primary care. Presented at: American Diabetes Association Scientific Sessions; June 20-23, 2025; Chicago.
Disclosures:
Perreault reports receiving personal fees for speaking and/or consulting from Ascendis, Boehringer Ingelheim, Eli Lilly, Medscape, Novo Nordisk, UpToDate and WebMD.
